Former Midlothian football player Ryan Looney, who injured his spinal cord in 2006 while playing in a Midlothian football game, plays with his dog Roscoe at his home, in Ovilla, TX on November 9, 2013. (Kye R. Lee/The Dallas Morning News)

In the land of multimillion dollar stadiums and NFL-caliber indoor practice facilities, the perception is that Texas high school athletic programs spare no expense.

Yet there is a small item overlooked by some districts. If a student athlete without health insurance gets severely injured, that could lead to financial ruin for the family and a diminished health outcome for the player.

Catastrophic care insurance offers a safety net for students who suffer life-altering accidents or illness while participating in an extra-curricular school activity, with policies providing as much as $7.5 million of coverage in cases such as spinal cord injuries, brain injury, infection or stroke. But coverage is not mandatory in Texas, nor is it officially recommended by the state’s public school extracurricular governing body, the University Interscholastic League.

A Dallas Morning News survey of 65 of the largest school districts in the Dallas-Fort Worth area found five that don’t provide any catastrophic care coverage: Birdville, Burleson, Cedar Hill, Mansfield and Richardson ISDs.

While some states require that schools or student athletes carry insurance, even providing it in some cases, Texas, which has a level of uninsured 1.5 to 2 times the national average, does not.

“I find it a little odd [schools] don’t carry it,” said Ryan Looney, a former Midlothian football player who suffered a serious spinal injury during a JV game in 2006.

“You look at the sport of football in Texas: It’s life,” he said. “These kids live and breathe it. You look at the impact it has on schools in general, the amount of money it brings in — from boosters to people attending games on Thursday and Friday nights — it’s bizarre to think that you can’t cover these kids that are playing a sport that has come to light to be very dangerous, whether it’s concussions or injuries like mine.

“Why not have that added protection for your students? It’s not a guarantee that it’s going to help them or that they’ll ever use it, but it’s better than nothing.”

‘A minute cost’

Catastrophic care coverage is designed to provide for the tremendous costs resulting from a serious injury during a school event, such as spinal cord injuries suffered in football or brain and spinal trauma resulting from falls in cheerleading.

Disability benefits, in-home custodial care and mobility equipment are among the items paid for from these policies, with maximum benefit levels ranging from $1 million to $7.5 million.

Parents and guardians are responsible to reach the deductible — on average, $25,000 — before the policy kicks in. That amount is steep, so much so that most commonplace sports injuries — broken bones and ACL tears — don’t approach the deductible, unless there are complications.

Certain districts choose to go beyond that level of coverage, providing supplemental policies to offset the deductibles that parents’ or guardians’ primary insurance may incur. Supplemental insurance can also serve as a primary policy if the parents don’t have insurance.

Dallas ISD head athletic trainer Phil Francis estimated that about 65 percent of Dallas’ student population involved in athletics is without health insurance. DISD pays for one of the more robust student-insurance plans in the area — providing both catastrophic care coverage and a supplemental policy that would cover up to $25,000.

“And for a family that has no insurance, if they support our documentation — they sign off and honorably say that don’t have other insurance — ours becomes the primary,” Francis said.

Since catastrophic policies are rarely called on to pay benefits, the plans are far less expensive than other policies the district might provide.

Mesquite ISD, for example, provides $6 million in coverage for every student in any school-related extracurricular activities, such as band or one-act play. It also covers each of the district’s eight junior high school campuses. The policy for the 2013-14 school year cost $7,524.

Kent Holbert, an insurance agent for Texas Student Resources, said an average school district with one high school and one junior high in his coverage area is “probably paying a little under $2,000, probably around $1,600” annually to carry catastrophic injury insurance.

Largely working with schools in East Texas, Holbert estimated that 90 percent of the football-playing schools he covers carry a catastrophic plan.

“It’s incredible how many Texas kids have no insurance,” Holbert said. “I certainly think [catastrophic care insurance] is a minute cost compared to some of the other budgetary items they have.”

Stephenville ISD assistant athletic director and head athletic trainer Mike Carroll said that his district eliminated its supplemental coverage a few years ago during the state’s budget crunch. As few as 50 students were filing claims per year on a policy that cost $50,000.

But Carroll, who serves as the Texas State Athletic Trainers Association’s liaison to the UIL Medical Advisory Committee, lobbied to keep the catastrophic policy, which costs around $3,000.

“To put it in perspective, it’s less than the cost of sending our cross country runners on a charter bus to the Region I meet in Lubbock,” Carroll said.

‘Some districts do, some don’t’

So why don’t all schools carry such an inexpensive policy? It’s a combination of long-held practices, misinformation and a lack of understanding of how many schools actually provide insurance at some level.

Former Cedar Hill ISD chief operating officer Kim Lewis — the acting superintendent until stepping down two weeks ago — said, to his knowledge, the district has never discussed adding the policy. The school’s counsel has advised against the district providing any policy to students, Lewis said, to avoid “using public funds for personal gain.”

According to a three-year estimate from the American Community Survey, 16 percent of Cedar Hill’s student-aged population (6- to 17-year-olds) is without health insurance.

Outside head football coach Joey McGuire’s office is a stack of pamphlets for student accident insurance, with an optional football coverage policy costing $230.

“I’ve always thought it was a good idea, but we’ve never done anything with it,” Cedar Hill athletic director Gina Farmer said about a catastrophic policy. “Obviously, the only time we get pushback from parents is when their kid’s hurt and they are out money.”

Both Lewis and Farmer said they would be interested in a catastrophic care policy for Cedar Hill, especially considering the cost and that their district is one of the area’s few holdouts.

“But I’ve been in meetings where we are cutting budgets, cutting people, cutting this and that, so I don’t know if it’s something that [the school board] would be interested in,” Farmer said.

Richardson ISD athletic director Bob Dubey said his district hasn’t provided catastrophic care insurance for at least 21 years. Instead, the district has relied on booster clubs from its four high schools — Richardson, Richardson Berkner, Richardson Pearce and Lake Highlands — to consider paying for a policy that covers their high school and feeder schools.

Only Pearce and Berkner’s booster clubs bought policies for the 2013-14 school year.

Lake Highlands campus coordinator and head football coach Scott Smith said that his booster club strongly considered purchasing a plan this season before opting not to.

Mansfield ISD — which has five high schools and six middle schools — did not include insurance as part of this year’s budget, according to Richie Escovedo, the district’s director of media and communications.

“From what we understand, some districts do, some don’t,” Escovedo said. “From our side, this was just something that was not included for ’13-’14.”

When asked how much it would have cost the district, Escovedo replied, “I don’t even think it got that far.”

One thing is clear, however. In its 11-page athletic packet, medical insurance is mentioned only twice — both marked in bold on the final page: “NOTE: Students are not insured under the MISD General Liability insurance policy.”

‘A real precarious position’

Catastrophic injuries aren’t common. According to the National Center for Catastrophic Sport Injury Research, 468 “non-fatal” injuries — where “permanent severe functional disability” is the result — have occurred in the United States from direct participation in high school sports from 1982 to 2011.

Eddie Canales is the executive director of Gridiron Heroes, a Texas-based nonprofit that helps high school football players who have suffered catastrophic spinal cord injuries. He estimated that since his group was founded in 2003, an average of two Texas football players have suffered significant spinal cord damage each year.

When those injuries occur, the cost for care is staggering. A 2011 National Spinal Cord Injury Statistical Center estimate said that for those who suffer high tetraplegia — partial or total loss of use of all the limbs — the first-year cost for care was $1,044,197, with each subsequent year costing $181,328.

Ryan Looney, the Midlothian player, fractured his fourth vertebra while making a tackle in a JV game against Fort Worth Brewer in 2006. He left the field strapped on a spine board, unable to move and without feeling in his extremities. He spent a week in intensive care and stayed in the hospital for another three months while in rehabilitation at Baylor Dallas. Ryan’s father, Warren, had retired from AT&T before the injury happened but had elected to pay a higher premium to keep his normal health care insurance.

“Just the helicopter CareFlite charge from Midlothian to the hospital, it was outrageous,” Warren Looney said. “I’d still be trying to pay it off today.”

The day before Thanksgiving in 2006, Looney walked out of the hospital using a cane.

He has Brown-Séquard syndrome, suffering mobility issues on his right side, and touch and sensation issues on his left. But he considers himself fortunate to not live life in a wheelchair.

“If I hadn’t had any insurance at all, we’d have been in a real precarious position,” Warren Looney said. “It would have bankrupted me if the school didn’t have some kind of catastrophic insurance. [In reality] I was covered on both ends — not totally 100 percent, because I still had to pay deductibles and things like that. But without it, I would have been in trouble.”

Other states’ mandates

While other states have recently made moves to require catastrophic care insurance, the UIL and the Texas Legislature have left the issue as a local decision for school districts.

In August, Illinois Gov. Pat Quinn signed into law a requirement that Illinois public and private school districts provide catastrophic care insurance for students injured in school-sponsored events. The new mandate received national media coverage; the requirement, however, isn’t unique.

Several state athletic organizations require or even provide catastrophic care coverage. For example, the Arkansas Activities Association provides a $1.5 million policy to its schools, funded by benefit games that each member school plays throughout the year in nine team sports. Arizona’s Interscholastic Association requires each school to have policy and has collectively negotiated a $4 million catastrophic policy at a rate of $5.60 per student. Florida’s high school athletic association not only demands that its schools carry at least a $1 million catastrophic plan but also requires all participants to be covered through their family’s medical insurance or purchase a school-offered plan for base medical coverage.

Prior to the legislation, the Illinois High School Association had provided catastrophic coverage for those competing in post-season events — a plan that assistant executive director Matt Troha said had been in place for decades. The IHSA will now offer a catastrophic plan for districts, at the cost of approximately $3.33 per student, to get schools into compliance.

‘Doing your due diligence’

The UIL, however, leaves the decision on whether to carry coverage up to its member school districts. A 2004 UIL survey of superintendents found 202 of the 1,010 respondents did not carry catastrophic insurance on extracurricular participants.

The Texas Association of Private and Parochial Schools also doesn’t require coverage but does highly recommend some form of coverage for its member schools.

“Schools can do that now, if they choose to,” UIL athletic director Mark Cousins said. “And I think that’s what a lot of our superintendents would indicate on that: ‘It’s a local issue. We have an opportunity to do that now if we want to.’ But if someone feels like this needs to be a statewide movement or issue, obviously we have a process by which that can occur.”

Most coaches and administrators who spoke with The Dallas Morning News said they are reluctant to add an unfunded mandate on districts, despite already carrying a policy.

“We don’t have to provide any of this according to any state laws or the UIL,” Greenville athletic director and head football coach Marvin Sedberry said. Greenville provides a $7.5 million catastrophic policy, as well as a $500,000 cash benefit for paralysis, coma or brain death. “We do it because our school district has about 70 percent free and reduced lunch. If that means they’re living near the poverty level, that means they may not have insurance.”

D.W. Rutledge, the executive director of the Texas High School Coaches Association (THSCA) and a member of the UIL’s Medical Advisory Board, said he was personally in favor of schools carrying a policy.

Regardless of the financial situation of a severely injured player, THSCA provides $150 per month for life for catastrophically injured athletes if their high school coach was a member. Soberingly, THSCA also provides a $3,000 check to parents after their child’s death.

“It’s something for them to know we haven’t forgotten about them,” Rutledge said. “Basically, it’s a love offering.”

Both Rutledge and Cousins said that the issue of mandating insurance coverage has not been recently discussed by the league’s Legislative Council or its Medical Advisory Board. The league, however, is always looking to “see what best practices are,” Cousins said.

Unfortunately, sometimes the catalyst for adding policies is a spinal injury within the district or area.

Carrollton-Farmers Branch ISD added a $5 million policy in August 2004, after Carrollton R.L. Turner’s Nat Little was paralyzed in a spring football game that year.

Dallas ISD added its catastrophic policy in 1991, a year after North Dallas senior Wendell Murphy suffered a paralyzing injury during a football scrimmage.

Francis was the first medical assistance on the scene to help Murphy.

“That was a tipping point,” Francis said. “We had been pushing for that, strongly suggesting to carry a ‘cat’ plan at least for those catastrophic issues. It’s too bad that’s what it took.”

Staff writers David Just, Kyle Fredrickson and Daniel Lathrop contributed to this report.

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